nurse-manager for a hospital floor and focuses on a proposed change to that floor: the addition of a certified wound care nurse. It begins by describing the benefits of a specialized wound care nurse, the existing conditions on the hospital floor, and how each of the stakeholders would be impacted by such a change. It utilizes Lippitt's phases of change theory to describe how those changes would be implemented on the floor, outlining each of the phases in implementing such a change.
Wound care nurses play a special role in the hospital environment, and hospitals without those specialized nurses may not be able to offer the level of care as hospitals that have these specialized professionals. "Wound care nurses, sometimes referred to as wound, ostomy, and continence (WOC) nurses, specialize in wound management, the monitoring and treatment of wounds due to injury, disease or medical treatments. Their work promotes the safe and rapid healing of a wide variety of wounds, from chronic bed sores or ulcers to abscesses, feeding tube sites and recent surgical openings" (Nursing Schools, 2012). While it may seem as if any nurse should be qualified to perform these functions, it is critical to realize that it is a specialized field. "Their main objectives are to assess the wounds, develop a treatment plan, clean wounds and monitor for signs of infection. If the wounds become worse, the nurses must be able to recognize symptoms that could require surgical debridement or surgical drains. Wound care nurses also work with patients and other care givers to educate them on wound prevention" (Nursing Schools, 2012). While it may be possible for other types of nurses to provide the same type of care as wound care nurses, it is unlikely that they can provide the same level of care as these specialized nurses. Therefore, best practices suggests that a hospital with a high degree of wound patients employ a wound care nurse to manage these injuries and engage in patient education about wound care. Because it has a high number of serious wound patients, the hospital where I work would benefit from the addition of a wound-care nurse. This paper will use Lippitt's phases of change theory to describe how to tackle the challenges of getting a certified wound care nurse for this hospital floor.
At this time, I work in a hospital with no dedicated wound care nurse. I work on the orthopedic and post trauma floor as a staff nurse. As a staff nurse, part of my duties include wound care. However, some of the wounds that we see on that floor are very serious and require special knowledge to treat them. While the nurses on my floor are adequate at caring for the wounds, sometimes learning about the specialized care for the wounds requires additional time that delays services to all patients, not simply the patients with the serious wounds. I believe that the addition of a wound care nurse would provide significant benefits to the hospital. Most importantly, having a dedicated wound care nurse would increase the quality of patient care, the most important consideration when looking at additions to a hospital's nursing staff. However, the addition of a dedicated wound care nurse would have benefits beyond those to the patients. The nurse would reduce staffing concerns for the nurse managers, would reduce the burden on floor shift nurses, and more properly align nursing duties with the industry standards for the job performance.
The hospital where I work would benefit from the addition of a wound-care nurse. The floor nurses will continue to handle their routine assignments, and the wound care nurse's sole responsibility will be caring for wounds.
There are several stakeholders involved in the implementation of any change in the hospital. The first set of stakeholders includes the hospital's board of directors, who have to manage the hospital's budgetary issues. The second set of stakeholders includes the staff at the hospital. The third set of stakeholders includes the patients. While it may seem that all three sets of stakeholders would have similar interests, that is a gross oversimplification of personal stakes in the scenario. Yes, all three groups have the same over-arching goal: the provision of affordable, high-quality health care in a friendly environment.
However, each subgroup is driven by a set of primary concerns. For example, the directors not only have to worry about budgeting for an additional staff member, but also about the consequences of hiring a wound care specialist. If they have a wound care specialist and another nurse manages wound care for a patient and it results in infection or other loss, does the fact that they had a specialist and did not use the specialist for the care raise liability issues? Does the hospital's failure to have a specialist, on its own, raise liability issues? Those are the concerns that the directors must consider when looking at this change.
The nurses would theoretically unilaterally support the addition of a wound care specialist because it would free them up for their other duties. However, a wound care specialist might undermine the apparent authority of the nurses. At this point, the lack of a wound care specialist almost certainly compromises patient care. For example, studies "suggest that individuals claim to access research knowledge via media such as journals whilst in reality consulting colleagues from their own and other professions. Like nurses, doctors also have vested interests in claiming to use research information as the basis for practice (Thompson et al., 2001). This means that patients are almost certainly not getting the state-of-the-art care at this time, and the addition of a wound care specialist would reveal the gaps in service. Likewise, assuming a fixed nursing budget, the addition of a specialist who does not do the other duties of a floor nurse would probably mean no significant reduction in duties along with a reduced likelihood of raises.
It would seem that patients would have an interest in receiving the best-quality care, and the additional cost of a wound-care nurse, spread throughout all of the wounds on a floor, would not significantly increase their financial burden. However, one must acknowledge that patients grow attached to their floor nurses. Would having a dedicated wound care nurse undermine their confidence in their regular nurse? Would they resist having a nurse specifically dedicated to wound care? All of these questions help reflect the concerns of the patient-stakeholders.
There are two primary change theories to choose from when implementing change in a nursing environment: Lewin's change theory and Lippitt's change theory. Lewin's model theorizes a three-stage model of change known as the unfreezing-change-refreeze model (Kritsonis, 2004-2005). For Lewin, the driving forces are those forces causing change to occur, the restraining forces are forces that counter driving forces, and equilibrium is the state of being where driving forces equal restraining forces and no change occurs. The first stage, unfreezing, is the process which involves finding a method of making it possible to let go of old, counterproductive patterns. The second stage, change, involves a change in thoughts, feelings, or behavior. The third stage, refreezing, involves establishing the change as a new habit (Kritsonis, 2004-2005).
Lippitt's phases of change theory extends Lewin's three-step change theory. It looks at the roles and responsibility of the change agent, not simply the evolution of the change. As such, I find that it is a more appropriate way for me to tackle the challenges of instituting a change. The first step in Lippit's theory is to diagnose the problem. Step two is to assess the motivation and capacity for change. Step three involves assessing the resources and motivation of the change agent. Step four is to choose progressive change object, including the development of action plans and strategies. Step five is to select the roles of change agents. Step six is to maintain the change through communication, feedback, and group coordination. Step seven is for the change agent to gradually withdraw from the role over time (Kritsonis, 2004-2005).
Implementing the change
"The successful implementation of an evidence-based wound management program can be a complex process as there are many factors that inform the effective delivery of quality patient wound care" (McIsaac, 2007). Moreover, the success of implementing such a program is not based solely upon the quality of care given to patients with severe wounds. "Success can be achieved through the implementation of multiple clinical, educational, and operational strategies simultaneously including: a focus on patient centered care, a multidisciplinary approach to implementation, ongoing education for all stakeholders, a clearly articulated process for knowledge transfer, the creation of a comprehensive strategic plan, and a method for outcome measurement to evaluate and assess the effectiveness of the program" (McIsaac, 2007). Keeping all of the above factors in mind helps guide one through the steps in a change theory.
The first step in Lippit's theory is to diagnose the problem (Kritsonis, 2004-2005). I have already recognized that…